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Kidney Transplant

Summary

Update 2007

With sadness the case author is updating this case to include the fact that Sam passed away in March, 2006. His death had nothing to do with his transplant and everything to do with a freak accident. Sam was kicked in the leg by a cow and died from complications from that accident about a week later. Sam had attended a meeting the month before about being a participant in a team going to the 2006 Transplant Games in Louisville, KY. He reported that his transplant, then close to 9 years old, was going through gradual chronic rejection and that he knew he would sometime in the next few years need to either go on dialysis or get on a waiting list for a new kidney. His lab results at that time are not known. His main problem then was fatigue from anemia which was being treated with Procrit®, a brand of epo that helped to stimulate his red blood cell production. He was still working at the same company full time, and he noted that his daughter would graduate from high school that spring. Sam is greatly missed by all who knew him. He lived a full life despite the fact that it was tragic that he died at the young age of 37 from a totally unexpected strange accident after all he had come through.

Sam's brother, Charles, the donor, is now 33 years old. He has continued having annual with his primary care physician, a step recommended for all living donors. In July 2006 Charles' creatinine was 1.3 and in July 2007 it was 1.4. His blood pressure was excellent at 104/74. He is working full time, and he and his wife have had a child since he was a kidney donor 10 years ago. Charles has no regrets at having been a living donor for Charles. Despite his grief at losing his brother, he knows that his gift helped his brother to spend time with his family, work, hunt and have a good life for almost nine important years.

Charles will need to continue being checked regularly for the rest of his life to make sure his remaining kidney is functioning properly. Annually he needs to have a urinalysis for protein, a serum creatinine level and blood pressure check. It is not unusual for donors to have a somewhat higher creatinine level with one kidney than they had before donation with two kidneys. One possible risk for kidney donors is a higher risk of hypertension as the years go by after donation. For this reason it is wonderful to see that Charles has an excellent blood pressure reading of 104/74. If he were to ever develop blood pressure problems in the future, he would be treated for the problem like anyone else to protect his kidney.

The field of transplantation has changed in the decade since these brothers participated in living donor transplant. Several changes will be briefly noted here. For recipients one of the most significant changes has been the addition of more immunosuppressive medications that can be used to prevent rejection. Due to the use of improved immunosuppressive medications such as Prograf® and Cellcept®, many kidneys from living donors are functioning longer than in the past.  Some transplant centers are reporting an average of fifteen years graft survival from living donor kidneys.

For donors the most dramatic change has been the introduction and now widespread use of laparoscopic kidney removal. Today the vast majority of living donors have the less invasive surgery to remove a kidney by means of scopes and a much smaller incision than the older open method of nephrectomy (removing a kidney). With laparoscopic kidney donation, the donor’s abdomen is filled with carbon dioxide and scopes are used to clamp and cut the renal vein, artery and the ureter. The surgeon then removes the kidney through an incision on the abdomen. The hospital stay for the donors is now in the one to two day range, and the recovery time is much faster. Time away from work is reduced, but is still an issue for many people. There are still some financial barriers for donors despite work by Congress to pass organ donation bills to help donors.

Another change for kidney donors and recipients has been improved methods for increasing availability of organs when a specific donor and recipient do not match in terms of blood type. Tissue typing for matching of antigens is now less important than it was in the past due to more effective immunosuppressive medications. However, the ABO (blood type) still needs to match. Some centers such as Mayo Clinic are practicing procedures that can allow a person to better accept a kidney from a donor who does not have a compatible blood type, but despite this, it still remains a problem when people do not have compatible blood types.

The biggest change in this issue is called paired kidney donation. In paired kidney donation it is possible for people to donate to someone else than their relative or friend if they are not a blood type match. In other words, if Charles had had a different blood type than Sam and the transplant were to be done now, it would be possible at many centers for Charles to give to another person needing a kidney that he was compatible with and for Sam to receive a kidney from someone matching him. There is growth in the concept of paired donation around the United States and the passage of legislation that encourages this practice. Paired donation is one of the changes that have occurred to maximize the number willing people who can be living donors, especially because as of this date there are close to 98,000 people are the transplant waiting list. Many of these individuals are awaiting kidney transplants, and the demand remains greater than the supply. These are several of many important changes in transplantation since this case was first written.